A need has developed in the tissue implantation or transplantation, biomedical polymers, medical equipment, and drug delivery industries for a gentle and reliable sterilization method that results in greater than 106 log reductions of microbial and viral contaminants without impacting the properties of the material being sterilized. Indeed many new medical advances cannot be implemented because the sterilization industry is unable to provide a suitable sterilant as part of the manufacturing process.
In the case of polymers, gamma irradiation has been shown to compromise the mechanical properties.1 Furthermore, steam sterilization is incompatible with thermally or hydrolytically labile polymers. Ethylene oxide, a common and widely used sterilant, is toxic, mutagenic, and a carcinogenic substance that can react with some polymers, and also requires prolonged periods of outgassing. 1Jahan et al, “Long-term effects of gamma-sterilization on degradation of implant materials.” Applied Radiation and Isotopes: Including Data, Instrumentation and Methods For Use in Agriculture, Industry and Medicine 46(6–7): 637–8 (1995), incorporated expressly hereinto by reference.
Biological tissues, including macromolecular biopolymers, are also incompatible with steam. Gamma radiation results in a significant decrease in tissue integrity and bone strength.2 Certain antibacterial washes have been used to disinfect tissue, but incomplete sterilization is achieved and the washes leave residual toxic contaminants in the tissues.3 Ethylene oxide also reacts with biological tissue and is thus an undesirable sterilant for such reason. 2 Cornu et al, “Effect of freeze-drying and gamma irradiation on the mechanical properties of human cancellous bone”, Journal of Orthopaedic Research, 18(3), p. 426–31 (2000); and Akkus et al, “Fracture resistance of gamma radiation sterilized cortical bone allografts.” Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society 19(5): 927–34 (2001), the entire content of each incorporated expressly hereinto by reference.3Holyoak et al, “Toxic effects of ethylene oxide residues on bovine embryos in vitro”, Toxicology, 108(1–2, p. 33–8 (1996), the entire content of each incorporated hereinto by reference.
Many medical devices, such as stents, catheters and endoscopes, are fabricated from, or coated with, sensitive polymers that cannot tolerate steam, irradiation, or ethylene oxide. Plasma sterilization has been shown to be incompatible with some medical equipment and leaves toxic residues (Ikarashi, Tsuchiya et al. 1995; Duffy, Brown et al. 2000).4 4Ikarashi et al, “Cytotoxicity of medical materials sterilized with vapour-phase hydrogen peroxide.” Biomaterials 16(3): 177–83 (1995) and Duffy et al, “An epidemic of corneal destruction caused by plasma gas sterilization. The Toxic Cell Destruction Syndrome Investigative Team.” Archives of Ophthalmology 118(9): 1167–76 (2000), the entire content of each expressly incorporated hereinto by reference.
Recently, in U.S. Pat. No. 6,149,864 to Dillow et al (the entire content of which is expressly incorporated hereinto by reference), the use of supercritical CO2 was disclosed as an alternative to existing technologies for sterilizing a wide range of products for the healthcare industry with little or no adverse effects on the material treated.
Specifically, the Dillow '864 patent disclosed the inactivation of a wide range of vegetative microbial cells using supercritical carbon dioxide with agitation and pressure cycling. However, only one spore-forming bacterium was investigated in the Dillow '864 patent, specifically, B. cereus. No disclosure appears in Dillow '864 patent regarding the efficacy of the therein suggested techniques using currently accepted bio-indicator standards used to judge sterilization (i.e., B. stearothermophilus and B. subtilis). Subsequently, however, other investigators achieved only a 3.5 log reduction in B. subtilis spores using the method disclosed in the Dillow et al '864 patent.5 5Spilimbergo et al, “Microbial inactivation by high-pressure.” J. Supercritical Fluids 22: 55–63 (2002), the entire content expressly incorporated hereinto by reference.
Bacterial spores are more difficult to sterilize than vegetative cells. B. stearothermophilus and B. subtilis spores represent the greatest challenge to sterilization methods (FDA 1993) and are the currently accepted standards within the industry for validating sterilization methods. Sterilization is defined as greater than or equal to 6-log (106)reduction in colony forming units (CFUs). Reproducible inactivation of these resistant microbes is required for commercialization of novel sterilization equipment and processes.
It therefore would be highly desirable if sterilization methods and apparatus could be provided which are effective to achieve a 6-log reduction in CFUs of industry standard bacterial spores. It would more specifically be especially desirable if sterilization methods and apparatus could be provided that achieve a 6-log reduction in CFUs of B. stearothermophilus and B. subtilis spores. The present invention is therefore directed to fulfilling such needs.